Sunday, February 19, 2017

The Oregon Health & Science University (OHSU) Biomedical Informatics Graduate Program is renaming the two tracks of its program. While the changes to the names of the tracks are small, they reflect the big changes in the field and evolving content of the curriculum.

Since 2006, the program has had two “tracks,” which have been called Clinical Informatics (CI) and Bioinformatics & Computational Biology (BCB). These two pathways through the program have been called “tracks” because they represent two different foci within the larger field of biomedical informatics, which is the discipline that acquires, organizes, and uses data, information, and knowledge to advance health-related sciences. Historically, the differences between the tracks represented their informatics focus, in particular people, populations, and healthcare (clinical informatics) vs. cellular and molecular biology, genomics, and imaging (bioinformatics).

In recent years, however, these distinctions have blurred as “omics” science has worked its way into clinical medicine. At the same time, health, healthcare, and public health have become much more data-driven, due in no small part to the large-scale adoption of electronic health records. As such, the two tracks have begun to represent different but still distinct foci, mostly in their depth of quantitative methods (deep vs. applied) but also in coverage of other topics (e.g., system implementation, especially in complex health environments; usability; and clinical data quality and standards).

The program believes that both tracks possess a set of common competencies at a high level that reflect the essential knowledge and skills of individuals who work in biomedical informatics. The curriculum organizes these competencies into “domains,” which are groups of required and elective courses that comprise the core curriculum of each track. To reflect the evolution of the program, the program has renamed the BCB track to Bioinformatics and Computational Biomedicine (still abbreviated BCB) and the CI track to Health and Clinical Informatics (now to be abbreviated HCI). The table lists below lists the common competencies and the names of the domains for each track. Each of the domains contains required courses, individual competency courses (where students are required to select a certain number of courses from a larger list, which used to be called “k of n” courses), and elective courses.

The program will continue the overall structure of the curriculum with the “knowledge base” that represents the core curriculum of the master’s degree and the base curriculum for advanced study in the PhD program. A thesis or capstone is added to the knowledge base to qualify for the MS or MBI (latter in the HCI Track only) degrees, respectively. Additional courses are required for the PhD, ultimately culminating in a dissertation.

Wednesday, February 1, 2017

Many aspects of academic medicine, from the structure of the medical school curriculum to the organization of departments in Schools of Medicine, are neatly segregated into two buckets: basic science and clinical science. In the jargon of medical schools and education, basic science refers to the basic biomedical sciences that have traditionally been taught in the first two years of medical school, such as anatomy, physiology, biochemistry, and pharmacology. While plenty of clinical material has migrated into the first two years of medical school over the years, such as learning to interact professionally with patients and perform a physical examination, the main focus of the first half of medical school has historically been on basic science, culminating in the US Medical Education Licensure Examination (USMLE) Step 1 exam.

Once students finish their basic science years, they move on to the clinical sciences, where they begin rotations, also called clerkships or clinical experiences. They usually first rotate through the core medical specialties, i.e., internal medicine, surgery, pediatrics, obstetrics/gynecology, and psychiatry. This is then followed by rotations in other specialties and subspecialties, ultimately leading to graduation and the start of their residency training.

This division of medical education goes beyond just the medical school curriculum. The organizational structure in most medical schools is to group academic departments into basic science and clinical departments. These two types of departments usually have different funding models. Basic science departments are usually funded by base budgets for teaching and grants for research, with an expectation that just about all faculty have research grant funding. Clinical departments have base budgets and research programs as well, but they perform another activity, which is clinical care that provides practice opportunities (and revenues) for faculty and learning experiences for students, residents, and fellows. In many clinical departments in medical schools, research activity is modest and may be partially subsidized by the margins from clinical revenues.

The focus on these two groups of sciences takes the perspective of the physician taking care of a single patient, i.e., applying the best biomedical science through the lens of a specific clinical specialty. However, despite its primacy, there is more to the practice of medicine than taking care of single patients. Physicians and other clinicians work in a healthcare system that has other concerns, such as continually increasing costs, worries about patient safety, and questions about the quality of care delivered. As such, 21st century clinicians must be competent in more than the diagnosis and treatment of disease in individual patients. This has led to emergence of the notion of a “third science” of medicine, which focuses on how to optimally provide healthcare for patients and populations. While some describe this as “healthcare delivery science” (my preference) or “implementation science,” the emerging name, as given to a textbook in this area, is now “health systems science.”

The textbook is published by the American Medical Association (AMA), which has been supporting innovation in medical education through its Accelerating Change in Education (ACE) consortium, funded by grants to medical schools [1]. OHSU was one of the original grantees in this program to establish “medical schools of the future.” I have been pleased that one outcome of this program has been the expansion of instruction in clinical informatics for medical students, which I consider to be an essential competency for 21st century physicians [2].

The titles of the chapters of the new textbook describe the important topics covered by health systems science:

Health Systems Science in Medical Education

What Is Health Systems Science? Building an Integrated Vision

The Health Care Delivery System

Value in Health Care

Patient Safety

Quality Improvement

Principles of Teamwork and Team Science

Leadership in Health Care

Clinical Informatics

Population Health

Socio-Ecologic Determinants of Health

Health Care Policy and Economics

Application of Foundational Skills to Health Systems Science

The Use of Assessment to Support Learning and Improvement in Health Systems Science

The Future of Health Systems Science

I am delighted myself to be the lead author of one of the chapters, not surprisingly the one on clinical informatics [3]. I hope this chapter will introduce many new generations of medical and other health professions students to the informatics field and its role in healthcare delivery. Of course, informatics plays many roles beyond healthcare delivery, such as informing the care of individual patients and facilitating all types of research, but the effective use of data and informatics is a key aspect of health systems science.

I hope that this new textbook will lead the way in emphasizing the importance of health systems science in the work of physicians and other healthcare professionals. Clinicians have long known that diagnosing and treating disease, while the centerpiece of medical practice, cannot be carried out in a vacuum outside the realm of the patient’s and larger health system’s context. The care delivered to those individual patients will be better if the clinician has the perspective of that larger system.